1. A 30-year-old single male presented to a mental health ...

1. A 30-year-old single male presented to a mental health clinic with his elderly mother.

She brought him there because her son would not leave the house to fulfill his jury duty.

He had been summoned several times over the last eight years, and was now facing legal

charges for the failure to serve. The patient appeared anxious and unwilling to

Give much of his history. His mother provided some information, and it became evident that the

patient had not left his mother¡¯s house at all for years. His mother had informed the courthouse

clerk, who recommended the mental health evaluation. Family members sometimes observed

him rocking in a chair in the living room and talking to himself; otherwise he isolated himself to

his bedroom. Only months later did he reveal to a therapist that he had heard voices as a

teenager, telling him to go out and kill people, so he stayed indoors instead for safety. His

sleep and appetite were normal. He denied any episodes of physical discomfort or sense of

doom. He was not using any substances. He was well oriented and had no memory problems.

CT of the brain revealed only mildly enlarged ventricles. Which of the following is the most likely

diagnosis?

A.

B.

C.

D.

E.

Avoidant personality disorder

Social anxiety disorder

Early onset dementia

Panic disorder with agoraphobia

Schizophrenia

2. Which of the following statements best describes the treatment of bipolar depression?

A.

B.

C.

D.

E.

Antidepressants are as effective in bipolar as in unipolar depression

Antidepressants should never be used in bipolar depression

Psychotherapy is not necessary in bipolar depression

Antidepressants can destabilize bipolar mood disorders

Most experts agree on the best treatment for bipolar depression

3. Atypicals are associated with less extrapyramidal side effects compared to typical for the

following reasons:

A.

B.

C.

D.

Serotonin blockade promotes dopamine release

Atypicals do not bind as tightly and dissociate more quickly from the dopamine receptor

A only

A and B

4. A patient is asked how she is feeling. She replies, ¡°precarious, nefarious, astrocarious.¡± This

is an example of:

A.

B.

C.

D.

Tangentiality

Loosening of associations

Flight of ideas

Clanging

5. ¡°Astrocavious¡± is an example of:

A.

B.

C.

D.

Perseveration

Neologism

Confabulation

Flight of adeas

The following case will be used for questions 6 and 7:

A 30-year-old divorced woman is hospitalized on the acute psychiatry service after assaulting a

neighbor. She explains that the lights went out in her bathroom while she was washing and she

believed it was the neighbor¡¯s fault. Additionally, she heard people talking about how ¡°evil¡± the

neighbor is, and telling the patient she should retaliate. When questioned she admitted she had

been alone at home and hadn¡¯t seen anyone for days, but she was adamant about having heard

the conversations. The patient is known to the hospital staff due to previous hospitalizations.

She occasionally stops taking her medications and subsequently worsens to the point of

requiring admission. On this occasion she shared with her psychiatrist that she stopped the

medications because of a side effect that lets her know she is pregnant. Pregnancy test is

negative.

6. Of the following medications that this patient may have been prescribed, which is

most likely to have led to the nonadherence?

A.

B.

C.

D.

Lorazepam (Ativan)

Risperidone (Risperdal)

Aripiprazole (Abilify)

Bupropion (Wellbutrin)

7. Altered activity within which of the following neurotransmitter systems is most likely to be

responsible for this patient¡¯s stated side effects?

A.

B.

C.

D.

Testosterone

Acetylcholine

Dopamine

Gamma-Aminobutyric acid (GABA)

8. Which of the following neuroanatomical pairs are most likely involved in the development of

PTSD?

A.

B.

C.

D.

E.

Caudate and putamen

Amygdala and hippocampus

Brainstem nuclei and frontal eye fields

Thalamus and hypothalamus

Frontal cortex and insula

9. Tiffany is a fifteen-year-old female who was enrolled in counseling at the request of her

school guidance counselor. She is repeating ninth grade. (She failed last year because she

missed so much school due to suspensions that she was unable to keep up with the work.) She

is easily annoyed by and is annoying to others. Tiffany is noncompliant in school and in her

after-school program. She is rude and disrespectful when dealing with adults in authority but is

often seen smiling and interacting in a positive manner with her friends. However, when she

gets in trouble, she usually blames her friends and will not take responsibility for actions. Tiffany

sleeps and eats well. She is interested in becoming a hairdresser but is worried that she will not

graduate. Tiffany¡¯s diagnosis is probably:

A.

B.

C.

D.

Major Depressive Disorder

Oppositional Defiant Disorder

Schizophrenia

Posttraumatic Stress Disorder

10. A 75-year-old woman asks to speak privately to her husband¡¯s primary care physician. She

confides that for the last 6 months her 80 year old husband has been accusing her of having an

affair with their 35-year-old gardener. She is very humiliated by this, as in their 50 year

marriage, she has never been unfaithful. Her husband gets so furious that she sometimes fears

that he will hit her. Yesterday, she wore green slacks and he claimed this was a ¡°come-on¡± code

for the gardener. His behavior is otherwise unremarkable. The most likely diagnosis is:

A.

B.

C.

D.

E.

Bipolar Disorder

Delusional disorder

Schizophreniform disorder

Delirium

Pseudodementia

11. Which of the following presentations is most consistent with a diagnosis of ObsessiveCompulsive Disorder:

A. 7-year-old boy who presents complaining of hearing a voices accusing him of being ¡°sinful¡±

and ¡°evil¡± and provide a running commentary of his behaviors)

B. A 25-year-old woman who presents due to a ¡°shopping addiction¡±. She describes feeling a

strong, nearly irresistible urge to purchase excessive amounts of clothing and jewelry and

states she gets ¡°a rush¡± from shopping, though admits to significant guilt afterwards.

C. A 30-year-old single woman who lives with her parents and has few friends who presents

complaining of a 15 year history of extreme self-consciousness about her hair. She spends

several hours a day in front of the mirror brushing and styling her hair and often misses work

due to feeling ¡°too ugly to show my face in public¡±. She denies any other intrusive thoughts

or images or other compulsive behaviors.

D. A 20-year-old man who describes a three month history of worsening sadness, irritability,

difficulty sleeping, poor functioning at work, poor appetite and a preoccupation with death

and dying. He states that in the past 2 weeks he has become increasingly preoccupied with

the belief that his ¡°bowels are rotting¡± which causes him great distress and has led to

thoughts of suicide.

E. A 26-year-old pregnant woman who presents due to intrusive thoughts about harming her

child when he is born. She describes horrific violent thoughts and images which are

extremely distressing. She denies any history of violent behaviors but has a history of

intrusive thoughts that she might ¡°lose control and hurt someone¡± which has led to distress

and avoidance behaviors in the past.

12. A patient has been seeing you for psychiatric treatment of anxiety and difficulty forming

romantic relationships. She has incomplete memories of childhood. She calls for an

emergency appointment and reports that 2 days ago she paid a condolence call at an aunt¡¯s

house. When she entered she was flooded by returned memories of her sexual abuse by a

relative in that house during childhood. The defense mechanism that was lifted by returning to

the aunt¡¯s house is:

A.

B.

C.

D.

E.

Sublimation

Suppression

Repression

Isolation

Displacement

13. Jacob is a five year old male who has just started kindergarten. He attended pre-school but

was asked to leave because he was disruptive and unable to sit still. Jacob loves kindergarten.

He is a friendly, happy child who loves to play outside in the playground, especially games

which involve running. In the classroom, however, he is fidgety and has a hard time sitting still

long enough to take in the academic lesions. This makes Jacob sad. His parents, who are

professionals, are worried that Jacob will not get into Harvard and decide to take him for further

evaluation. What further information would be helpful to the evaluating clinician in order to

diagnose Jacob with Attention Deficit Hyperactivity Disorders:

A.

B.

C.

D.

Parents¡¯ reports about Jacob¡¯s behavior at home

Information regarding Jacob developmental milestones

Teacher¡¯s reports about Jacob¡¯s behavior in school

All of the above

14. A patient with a paranoid personality disorder has to wait several weeks for an appointment.

When you enter the examining room he says, ¡°been defending yourself in a malpractice suit?¡±

An appropriate response would be:

A.

B.

C.

D.

¡°I am a very busy doctor¡±

¡°No, how can I help you today¡±

¡°I can tell you¡¯re as amusing as usual¡±

¡°I¡¯m just back from a two week cruise¡±

15. You are assessing a patient and say to her ¡°What does ¡®A rolling stone gathers no moss

mean to you?¡± She responds by stating ¡°Because the stone is moving nothing can grow on it I

guess¡±. Her response can be best described by which of the following terms?

A. Abstract

B. Tangential

C. Circumstantial

D. Concrete

16. The following is NOT TRUE about self-injuurious behavior (SIB) in adolescents:

A. SIB is used to alleviate marked anxiety

B. A history of abuse is often an element of the past history of an adolescent who is selfinjurious

C. Treatment of SIB involves identifying the underlying emotional problem

D. Tattoos and body piercing are examples of SIB

17. Which of the following is true?

A. Individuals with Compulsive Hoarding often have good insight.

B. Compulsions are behaviors that are reinforced by the lessening of anxiety caused by

intrusive thoughts or images.

C. Individuals with Body Dysmorphic Disorder tend to enjoy attention and brag about their

appearance.

D. Body Dysmorphic Disorder is best classified as a type of Somatic Disorder because it has

many shared features with other Somatic Disorders.

E. Muscle Dysmorphia involves restricting food intake and an intense fear of gaining weight

associated with distorted body image.

The following case corresponds to questions 18 and 19:

A 25 year old white female is brought to the emergency department by two friends. The patient

is unresponsive and appears to be barely breathing. The patient¡¯s friends are clearly agitated,

but are able to provide you with some history. The state that they were all at a dance party

when they noticed their friend began acting strangely. They say that after returning from the

bathroom she seemed ¡°kinda dazed, like she was somewhere else.¡± She also kept repeating

¡°I¡¯m floating, I¡¯m floating.¡± She then reportedly began reaching out and picking at the air in front

of her. Finally, only after about a minute of this behavior, she passed out and began breathing

very slowly. They deny any knowledge about what the girl may have taken. They confirm that

the girl lives alone and is employed as a veterinary technician. On examination, the patient is

unresponsive to deep pain. Her respiratory rate is about 6. Her pupils are normally responsive

to light, but horizontal nystagmus is present. Hypersalivation is also noted. A small pinprick is

noted in the patient¡¯s left deltoid. The rest of her physical exam appears normal.

18. Which of the following should be done first in the management of this patient:

A. Administer naloxone.

B. Administer flumenazil

C. Intubation and ventilator support

D. Run a stat toxicology screen.

19. Which substance has this person likely taken:

A. Lorazepam

B. Heroin

C. Ketamine

D. MDMA

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